The candidate is an Associate Professor of Medicine at Boston University, and a clinical investigator at the Framingham Heart Study. His training in cardiology and epidemiology, mentoring and program development skills, and excellent track record in conducting and mentoring clinical research render him a suitable candidate for this research career award. During the award period, the candidate plans to spend 60% effort on the research outlined below, 25% effort on mentoring and 15% on clinical work. His long-term career objectives are to work as a clinical investigator building on the research theme of identifying preclinical heart failure (defining and screening for asymptomatic systolic and diastolic left ventricular dysfunction and evaluating their outcomes, examining roles of imaging techniques, biochemical markers, heritability), to mentor young clinical investigators, and to investigate cardiovascular disease in minorities. The interdisciplinary research group, the high-quality research infrastructure, the opportunities for mentoring, and the support of senior colleagues render the Framingham Heart Study and the Boston Medical Center ideal settings for the candidate's pursuit of his career as a clinical investigator. The proposed research extends prior work of the candidate identifying LV dilatation as a marker of subclinical left ventricular dysfunction and has the following specific aims: 1. To assess the prevalence of asymptomatic left ventricular dysfunction (systolic and diastolic). 2. To perform cross-sectional analyses on the relations of asymptomatic ventricular dysfunction to prevalent cardiovascular disease. 3. To perform cross-sectional analyses to assess the prediction of left ventricular dysfunction using a hierarchical model combining clinical data, with information on plasma levels of natriuretic pep tides and echocardiographic measurements. 4. To describe the natural history of asymptomatic left ventricular dysfunction (systolic and diastolic). The research will facilitate the development of cost-effective strategies to screen for preclinical heart failure. The mentorship plan consists of mentoring the research of and teaching a module on clinical research design to cardiology fellows at Boston Medical Center and at the Framingham Study. The mentorship plan will contribute directly to the growth and development of young clinical investigators at Boston Medical Center and the Framingham Heart Study.